Modified Socket Shield Technique Using a Crest-Level C-Shaped Shield and Digital Workflow: A Step-by-Step Protocol and One-Year Clinical Follow-Up

Abstract

The Socket Shield Technique (SST) has emerged as a promising approach for preserving facial bone and soft tissue contours during immediate implant placement in the esthetic zone. In this technique, the buccal portion of the tooth root – the socket shield – is intentionally retained with its periodontal ligament and blood supply to preserve the facial bone and support peri-implant soft tissue architecture. However, variations in shield morphology, thickness, and implant-shield gap management remain clinically significant and technique-sensitive. This case report presents a step-by-step protocol for a modified SST (M-SST), featuring a standardized 1.0–1.5 mm C-shaped shield reduced to the bone crest, and a fully guided digital workflow

A 39-year-old healthy, nonsmoking female with a hopeless maxillary central incisor (#8) underwent atraumatic extraction, buccal root shield preparation, and immediate implant placement. The socket shield was thinned to 1.0–1.5 mm, extended interproximally to preserve papillae, and reduced to the alveolar crest. A 3.3 × 16 mm Straumann BLT implant was placed palatal to the shield using a fully guided approach. Autologous particulate bone harvested from the maxillary tuberosity was placed because the implant℃shield gap exceeded 2 mm. A screwretained PMMA provisional crown was delivered on the day of surgery using a prefabricated Straumann Variobase NC abutment.

Follow-up at 1, 3, and 12 months confirmed excellent soft tissue volume stability, intact papillae, and complete bone fill between the shield and implant on CBCT. No complications such as shield exposure, displacement, or soft tissue recession were observed. A final zirconia crown was delivered at 4 months post-op with esthetic outcomes rated highly by both clinician and patient.

This case demonstrates that the modified SST, when performed with a standardized shield design, crest-level termination, and digitally guided implant placement, can yield favorable esthetic and functional outcomes. While grafting was selectively applied, the use of minimal intervention and immediate provisionalization contributed to soft tissue preservation. These results support the M-SST as a viable protocol for single-tooth rehabilitation in the esthetic zone.